A Comparison Between Endoscopic And Microscopic Transsphenoidal Approach For Nonfunctional Pituitary Adenomas

Objective: To evaluate the effect of two surgical methods on pituitary adenoma,based on the length of surgery,the length of postoperative hospital stay,gross total of tumor resection,symptom relief rate,and the incidence of postoperative complications through clinical comparison studies of microscopic versus endoscopic transsphenoidal surgeries in the treatment of nonfunctional pituitary adenomas.Subjects and methods: Data were collected from patients whose surgery had occurred in the period from September 2017 to November 2019 at the Department of Neurosurgery of the First Affiliated Hospital of Dalian Medical University.Patients who underwent microscopic or endoscopic transsphenoidal surgeries with postoperative pathology confirmed nonfunctional pituitary adenomas.The endoscopic component was group A(35 persons)and microscope component was group B(40persons).Clinical data(including age,gender,preoperative symptoms,Knosp grade,length of operation,postoperative hospital stay,etc.)were recorded separately.3-months follow-up postoperative MRI image data,endocrine tests,eye examinations,postoperative complications(including CSF leakage,anterior pituitary hypofunction,diabetes insipidus,nasal complications,intracranial infection,etc.).The measurement data were analyzed by SPSS software.The results were all expressed as mean ±standard deviation(x ± s).A p value < 0.05 was considered significant.Result: According to the statistical results,comparing the operation time andintraoperative blood loss between the microscope group and the endoscope group,the P values were 0.016 and 0.000,respectively,which was statistically significant.the postoperative hospital stay time(P = 0.156),no statistically significant.In terms of improvement of postoperative visual symptoms(P = 0.039),there was statistical significance,indicating that the endoscopic group could obtain better relief effects.Compared the microscope group with the endoscope group in overall complications(P = 0.021),the data are statistically different.The endoscope group has a lower incidence of complications,while for cerebrospinal fluid leakage(P = 0.536)and anterior pituitary dysfunction(P = 0.887),diabetes insipidus(P = 0.362),intracranial infection(P = 0.757),nasal complications(P = 0.194),the data results showed no statistical difference.The incidence of nasal complications in the microscope group was significantly higher than in the endoscopic group.Comparing the gross total resection rate of the microscope group and the endoscope group(P = 0.000)is statistically significant.The gross total resection rate of tumors that can be higher in the endoscope group.Compared with the total resection rates of tumors at all grades in the Knosp classification.All tumors at Grade 0 were completely resected,while at Grade 1(P = 0.091)was not statistically significant.Grade 2(P = 0.000)and Grade 3(P = 0.000)had statistical differences.For Grade 4tumors,no gross total resection was performed in both groups.In the study of tumor invasiveness,the comparison between non-invasive(Grade 0-1)and invasive(Grade 2-4)statistics showed that the non-invasive group(P = 0.207),without passing significance,while the invasive group(P = 0.000)has statistical differences,indicating that endoscopy can achieve better gross total resection rates in the removal of invasive pituitary adenomas.Conclusion: The results showed that compared with the microscope group,the endoscopic group has a higher gross total tumor resection rate,a lower complication rate,and a lower intraoperative bleeding volume,and has better visual outcome.It has better curative effect in the removal of invasive pituitary adenoma,but the operation time is significantly longer than that of the microscope group.